J Trauma
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Immune responses are markedly depressed very early after the onset of hemorrhage. Furthermore, endothelial cell dysfunction occurs after trauma-hemorrhage and may contribute to alterations in immune function. Recent studies have shown that administration of L-arginine restores the depressed organ blood flow, probably because of the provision of substrate for constitutive nitric oxide synthase. It remains unknown, however, whether administration of L-arginine would have any salutary effect on the depressed macrophage function after trauma-hemorrhage. ⋯ L-Arginine administration after trauma-hemorrhage significantly improves the depressed macrophage function, presumably by decreasing the increased plasma IL-6 levels and improving organ blood flow. Early enhancement of the depressed constitutive nitric oxide synthase activity by provision of L-arginine after trauma-hemorrhage, therefore, represents a novel and safe approach for improving the depressed immune function and decreasing plasma IL-6 levels under such conditions.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of performance of interns completing the old (1993) and new interactive (1997) Advanced Trauma Life Support courses.
The 1997 edition of the Advanced Trauma Life Support (ATLS) course emphasized interactivity as its major change. The impact of this change is assessed in this study. ⋯ Using standard ATLS pass criteria, performance after the new and old ATLS courses was similar. Superior performances were measured using OSCE methodology for clinical trauma management skills after the new compared with the old ATLS course in this population of interns.
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Prehospital blood transfusion for hemorrhaging trauma patients has been used infrequently and is controversial. Currently, there is no satisfactory nonsanguineous fluid therapy for use during prolonged transport, such as in military or rural trauma. ⋯ Prehospital blood transfusion is justified in certain trauma patients, especially when long prehospital transport is required. Blood may be safely maintained and used by physicians with little experience in care of major trauma.
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The rate and magnitude of pH changes in the bowel during hemorrhagic shock are greater than those in the stomach, implying that gastric intramucosal pH may not be a reliable indicator of gut perfusion. Here, we evaluate near-infrared spectroscopy (NIRS) to assess bowel pH in a swine shock model. ⋯ NIRS determination of small-bowel pH may be a good tool to monitor the adequacy of resuscitation.
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Postinjury neutrophil (PMN) priming identifies the injured patient at risk for the subsequent development of multiple organ failure (MOF). PMN priming has previously been shown to cause enhanced release of proteases and superoxide. PMNs, however, are a rich source of proinflammatory cytokines, such as interleukin (IL)-8 and tumor necrosis factor (TNF), which have been implicated in the development of MOF. PMNs also make IL-1ra, which is an anti-inflammatory cytokine that inhibits IL-1. It is our hypothesis that postinjury PMNs are primed for increased stimulated release of the proinflammatory cytokines IL-8 and TNF but not the anti-inflammatory cytokine IL-1ra. ⋯ After injury, PMNs are primed for proinflammatory cytokine release in addition to superoxide and elastase. This augmented release of IL-8 and TNF may be involved in the subsequent development of organ dysfunction and ultimately MOF.